Trekking Use Pattern and Perception of Users and Residents Towards Trekking Tourism in the Annapurna Sanctuary Trail, Nepal

The study assesses trekking use pattern and perception of trekkers and residents towards trekking tourism in the Annapurna Sanctuary Trail (AST) which is one of the most popular trekking areas in Nepal. Two separate questionnaire surveys, one representing 135 randomly selected trekkers and another involving 110 randomly selected households were conducted. The overall perception of trekkers was measured by a composite index developed from their opinions for six different attributes of the journey in the AST, where 1 represented most favourable perception and 4 represented most unfavourable perception. Likewise, residents' opinions on support for tourism, perception towards tourism's impacts and opinions for progressive tourism management statements were used in measuring the overall perception of residents, but in this case I represented most negative perception while 4 denoted most positive perception. It was found that the characteristics of the trekkers and pattern of use of the AST were not much different from other wilderness areas in the world. The per day expenditures of the trekkers in the AST was NRs . 222.2. They also spent large sum of money on trekking fees and porters and guides. However, this money is not retained in the area. Although the trekkers expressed somewhat unfavourable views towards litter condition and a few services, they in general showed positive view towards all attributes of the journey in the AST. It was noted that there were significant differences in the perceptions of trekkers towards various attributes of the journey in the AST; and area features was the most important factor in explaining the perception of journey in the AST

Predicting Deer Hunting Participation Using Theory of Planned Behavior and Constraint Integrated Theory of Planned Behavior Models: A Study of Oregon Big Game Hunters

Studies have established that the theory of planned behavior (TPB) is a simple but effective model for providing theoretical explanation as to why people participate in a given recreation activity, including general hunting activity. Understanding leisure constraints is another popular approach in leisure research, which is considered more useful from the practitioners\u27 point of view. Literature suggested that significant relationships exist between constraint dimensions and constructs of theory of planned behavior. It was assumed that integrating constraints to TPB might not only enhance the predicting power of the TPB but might also provide a practical dimension to it. The aims of this research were: (1) determine whether TPB can explain specific hunting activity (deer hunting), and (2) determine if the predictors of the TPB mediate the effects of different constraints dimensions on deer hunting intensions, and (3) determine if constraint integrated TPB can better explain deer hunting behavior than the original TPB. The data were collected from a two-staged mail back surveys of the hunters from Oregon in 2009 and 2010. The response rate was 20% and 67% in the 2009 and 2010 survey, respectively. Mediation analysis was conducted using Kenny\u27s Criteria. Model assessments were performed using structural equation modeling (SEM). Model comparison was done by comparing Chi-square ratio and AIC and BIC.;The findings of the research are presented in the form of three articles for peer reviewed journals, two of which have already published. The first two articles were based on the 360 responses received in 2009 mail back survey. The third paper was based on the responses of 242 respondents who participated in both 2009 and 2010 surveys.;Building on the exiting knowledge of application of TPB, the first article verified that TPB can successfully explain specific hunting intentions (deer hunting intentions) and unlike general hunting activity, specific hunting activity is less under volitional control. The second article expanded our knowledge regarding the roles of TPB constructs in mediating the effects of constraint dimensions on deer hunting intentions. It demonstrated that constraint dimensions are negatively related with the TPB constructs and TPB constructs mediated the effects of constraint dimensions on deer hunting intentions, directly and indirectly. The third article demonstrated that TPB can successfully describe deer hunting behavior and three constraint dimensions integrated TPB models could successfully explain more variance in reported hunting participation. It also provided opportunities of future research for leisure constraint researchers by providing the evidences of constraint negotiating roles of the TPB predictors.;Recommendations are made to use more comprehensive measures of attitudes, subjective norms and PBC as well as specific measures of constraints for better understanding of the entire phenomenon especially the specific roles of attitudes and subjective norms in the original and extended TPB model. Practitioners are advised to develop programs for enhancing PBC and for reducing internal and external constraints through skill development and providing more satisfying hunting opportunities by enhancing quality and quality of game population

Accuracy of bedside index for severity in acute pancreatitis ‘BISAP’ score in predicting outcome of acute pancreatitis

Introduction: Early identification of severe acute pancreatitis is of paramount importance in the management and for improving outcomes. Bedside index for severity in acute pancreatitis (BISAP) is a simple and accurate score for stratification in acute pancreatitis. This study was conducted to find out the accuracy of BISAP score in predicting outcomes of acute pancreatitis in local population. Method: We prospectively analyzed 96 patients with acute pancreatitis from February 2019 to December 2019. Revised Atlanta classification was used to stratify mild, moderately severe and severe pancreatitis. BISAP score was calculated within 24 hours of admission. Accuracy was measured by area under receiver operating curve (AUC). Result: Out of 96 patients, alcohol related acute pancreatitis accounted for 74.7%. There were 63.2% of mild AP, 37.3% of moderately severe AP, 9.4% of severe AP and 15.8 % of pancreatic necrosis. The AUC for moderately severe AP, severe AP and pancreatic necrosis were 0.77 (CI 0.68-0.87), 0.95 (CI 0.90-0.99) and 0.87 (CI 0.79-0.96) respectively. The statistically significant BISAP cut off for diagnosing sever AP was≥3, and ≥2 for moderately sever AP and pancreatic necrosis. There was positive correlation between revised Atlanta severity of acute pancreatitis and length of hospital stay (r=0.41). Mortality was 3.3 % which was seen in BISAP score 3 or above. Conclusion: BISAP is a simple predictive model in identifying patient at a risk of developing different severity of pancreatitis and its outcome in our population

Implementation of Collaborative E-learning System for Unstable Environment

We design a collaborative e-learning system for stable operation in an unstable environment of developing countries. The proposed system is used for providing a collaborative learning among local schools of rural area in Nepal. The stable operation of the system is realized by the redundant robustness in three different levels: network arrangement, energy management, and replicative database. In this paper, we present an overall design of the system and its use case. Then, methods adopted for achieving the redundancy in each level are described

Burden of Diabetes and Prediabetes in Nepal: A Systematic Review and Meta-Analysis

Unhealthy behaviors, such as energy-dense food choices and a sedentary lifestyle, both of which are established risk factors for diabetes, are common and increasing among Nepalese adults. Previous studies have reported a wide variation in the prevalence of prediabetes and diabetes in Nepal, and thus a more reliable pooled estimate is needed. Furthermore, Nepal underwent federalization in 2015, and the province-specific prevalence, which is necessary for the de novo provincial government to formulate local health policies, is lacking. This study aims to provide a comprehensive summary of the current literature on various aspects of diabetes in Nepal, i.e., the prevalence of prediabetes and diabetes as well as of the awareness, treatment, and control of diabetes in Nepal.This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched three electronic databases-PubMed, Scopus, and Web of Science-using a comprehensive search strategy to identify eligible studies published up to April 2, 2020. Data on prevalence estimates of prediabetes and diabetes were extracted and pooled in a meta-analysis using a random effect model. Subgroup analyses and meta-regression were conducted to assess heterogeneity across the studies. The quality of included studies was assessed using the New Castle-Ottawa scale.We included 14 eligible studies that comprised a total of 44,129 participants and 3517 diabetes cases. Half of the included studies had good quality. Overall, the prevalence of prediabetes and diabetes was 9.2% (95% CI 6.6-12.6%) and 8.5% (95% CI 6.9-10.4%), respectively. Among the participants with diabetes, only 52.7% (95% CI 41.7-63.4%) were aware of their diabetes status, and 45.3% (95% CI 31.6-59.8%) were taking antidiabetic medications. Nearly one-third of those under antidiabetic treatment (36.7%; 95% CI 21.3-53.3%) had their blood glucose under control. The prevalence of prediabetes and diabetes gradually increased with increasing age and was more prevalent among males and urban residents. There was a wide variation in diabetes prevalence across the provinces in Nepal, the lowest 2% in Province 6 to the highest 10% in Province 3 and Province 4.The prevalence of prediabetes and diabetes was high in Nepal, while its awareness, treatment, and control were low. Our findings call for urgent nationwide public health action in Nepal

Health system’s readiness to provide cardiovascular, diabetes and chronic respiratory disease related services in Nepal: analysis using 2015 health facility survey

BACKGROUND: The burgeoning rise of non-communicable diseases (NCDs) is posing serious challenges in resource constrained health facilities of Nepal. The main objective of this study was to assess the readiness of health facilities for cardiovascular diseases (CVDs), diabetes and chronic respiratory diseases (CRDs) services in Nepal. METHODS: This study utilized data from the Nepal Health Facility Survey 2015. General readiness of 940 health facilities along with disease specific readiness for CVDs, diabetes, and CRDs were assessed using the Service Availability and Readiness Assessment manual of the World Health Organization. Health facilities were categorized into public and private facilities. RESULTS: Out of a total of 940 health facilities assessed, private facilities showed higher availability of items of general service readiness except for standard precautions for infection prevention, compared to public facilities. The multivariable adjusted regression coefficients for CVDs (β = 2.87, 95%CI: 2.42-3.39), diabetes (β =3.02, 95%CI: 2.03-4.49), and CRDs (β = 15.95, 95%CI: 4.61-55.13) at private facilities were higher than the public facilities. Health facilities located in the hills had a higher readiness index for CVDs (β = 1.99, 95%CI: 1.02-1.39). Service readiness for CVDs (β = 1.13, 95%CI: 1.04-1.23) and diabetes (β = 1.78, 95%CI: 1.23-2.59) were higher in the urban municipalities than in rural municipalities. Finally, disease-related services readiness index was sub-optimal with some degree of variation at the province level in Nepal. Compared to province 1, province 2 (β = 0.83, 95%CI: 0.73-0.95) had lower, and province 4 (β =1.24, 95%CI: 1.07-1.43) and province 5 (β =1.17, 95%CI: 1.02-1.34) had higher readiness index for CVDs. CONCLUSION: This study found sub-optimal readiness of services related to three NCDs at the public facilities in Nepal. Compared to public facilities, private facilities showed higher readiness scores for CVDs, diabetes, and CRDs. There is an urgent need for policy reform to improve the health services for NCDs, particularly in public facilities

Partial edentulism and its correlation with educational status: a hospital-based study

Background: Maintenance of oral hygiene is one of the most important factors to prevent tooth loss. Education plays a significant role to maintain good oral hygiene. The objective of the study was to determine partial edentulism based on Kennedy’s classification and to find out correlation between partial edentulism and educational status. Methods: A cross-sectional study was carried out among 189 partially edentulous patients visiting dental OPD of three government hospitals. Patients above 18 years of age were selected using non-probability convenience sampling, 63 from each center. History taking and visual examination were done after getting informed consent from the participants. Descriptive (mean, median, standard deviation, range, ratio and percentage) and inferential (Man-Whitney test) statistics were applied. Results: In 189 partially edentulous patients 61% were females and 39% were males, and 48.1% people had no formal education. Kennedy’s Class III was most common (59% in maxillary, 61% in mandibular arches) and Kennedy’s class IV was least common (1% in maxillary, 6% in mandibular arches). From the study, we found that the number of teeth missing was higher in people with no formal education and there was statistically significant difference in the number of missing teeth in people with formal education and people who didn’t have any formal education (p<0.05). Conclusion: The study showed that education plays a vital role in generating awareness about maintenance of oral hygiene and people who are educated have a tendency of retaining more of their natural dentition. Preventive educational programs should be focused in the low education group so that more effective outcomes can be achieved. Keywords: Caries, Edentulism, Kennedy’s classification, Oral hygiene, Periodontal Diseas